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§ 23-99-902. Definitions

AR Code § 23-99-902 (2018) (N/A)
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(1) "Alternative payment system" means a payment methodology used by a healthcare payor that includes a risk-sharing or gain-sharing component for a physician that participates in a plan, program, or network offered by the healthcare payor;

(2) "Gain-sharing payment" means an increase in a payment or additional payments made by a healthcare payor to a physician as a result of patient care costs that fall below cost thresholds of any form;

(3)

(A) "Healthcare payor" means an entity that reimburses a physician for the delivery of healthcare services that are covered by a plan administered, issued, or delivered by the entity.

(B) "Healthcare payor" does not include a provider-based network or system that utilizes risk-sharing including an accountable care organization or a clinically integrated network; and

(4) "Risk-sharing payment" means a reduction in a payment to or refund of a payment already made to a physician as a result of patient care costs that exceed cost thresholds of any form.

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